Patients with Acute Myocardial Infarction and Unstable Angina Have Significant Levels of Anteceding Stress

Abstract Objective: There is a significant correlation between stress and coronary artery disease when the stress is continuous and extreme. This study aims to determine the relationship between stress-related psychosocial factors, namely anxiety, depression, and life events, with ischaemic heart disease. Patients and Methods: Two sets of questionnaires--The Hospital Anxiety and Depression Scale and Rahe's Life Changes Stress Test--were administered to 3 groups comprising 36 patients with acute myocardial infarction or unstable angina, 38 outpatients from the Cardiology Clinic at the Universiti Kebangsaan Malaysia, and 25 healthy people from the community. All participants rated their feelings and reported any major lifestyle changes in the 6 months prior to interview. Results: The study group had significantly higher odds of having had mild anxiety and depression and moderate-risk life events when compared to the healthy participants. There was no significant difference between the case group and the outpatients. Conclusions: Psychosocial factors relating to stress is present in patients with acute ischaemic heart disease. Outpatients who have had long-term cardiac tribulation have the same odds for anxiety, depression, and life events as the patients with acute myocardial infarction. Key words: Anxiety, Depression, Myocardial infarction, Psychological stress, Unstable angina Introduction The dramatic decline in cardiovascular disease in developed countries during the past 40 years is primarily due to the optimal intervention of traditional risk factors such as cigarette smoking, elevated total and low density lipoprotein (LDL) cholesterol, elevated blood pressure, low high-density lipoprotein (HDL) cholesterol, and diabetes mellitus. (1) However, many of these patients continue to have cardiac events due to the emergence of other non-traditional predisposing factors such as psychosocial stress. Psychosocial stress worsens the risk associated with the traditional risk factors and contributes to mechanisms underlying cardiac events, especially endothelial dysfunction, myocardial ischaemia, plaque rupture, thrombosis, and malignant arrhythmias. (2) Any programme designed to reduce morbidity and mortality of patients with coronary artery disease will be incomplete without addressing the relationship to stress. (3) In Malaysia, the leading cause of death in government hospitals is cardiovascular disease, with coronary heart disease being the major cause of mortality (24.5% of all deaths in the government hospitals). (4) Ischaemic heart disease such as acute myocardial infarction (MI) is a major health problem, with relatively high mortality and morbidity. Mental stress, in particular, has long been implicated as a potential trigger for MI and sudden cardiac death. (5) Although risk of death or ischaemic complications with unstable angina is lower than with MI, patients with this condition were also included in the study as they tend to rapidly progress to MI and symptoms for most of these patients are caused by significant coronary artery disease. Measuring psychological variables may address the mediators in which stress affects health or illness. Although the question of whether life events can increase the rate of psychiatric morbidity is still inconclusive, epidemiological studies attributed 32% of psychiatric illness to stressful life events. (6) Developing either depression or anxiety has been linked to stressful life events involving loss (e.g., death of a loved one), which is more likely to lead to depression, while events involving threat (e.g., an accident) lead to anxiety. (7) In this study, both anxiety and depression will be assessed using the Hospital Anxiety and Depression Scale (HADS), which establishes the presence and severity of both anxiety and depression simultaneously, while giving a separate score for each. Life events scores were measured using Rahe's Life Changes Stress Test, a part of the Stress Coping Inventory. …